San Bernardino County Elections Office
2017 Poll Worker Application
1. Applicant Information (Please print clearly)
First Name
Last Name
Birthday (mm/dd/yy)
Street Address
Unit/Apt #
City
State
Zip Code
Mailing Address (If different)
Unit/Apt #
City
State
Zip Code
Phone Number
Cell Phone Number
Do you have access to a vehicle? Yes
No
Email Address
Are you registered to vote in the state of California? Yes
No
2. Skills and Experience (Please check all that apply)
What is your level of education?
High School
Some College
Undergraduate Degree
Advanced Degree
Election Experience
Professional Experience
Language Skills
Election Day Clerk
Administration/Clerical
Chinese
Spanish
Election Day Supervisor
Customer Service
Hindi
Tagalog
Election Day Field Rep
IT/Technical
Japanese
Thai
Election Day Machine Tech
Recruiting/Training
Khmer
Vietnamese
Other:_____________________
Supervisory
Korean
Other _____________
3. Availability
Are you currently employed?
Yes
No
If Yes, list employer:
Are you available Election Day from 6:00 am to 9:00 pm?
Yes
No
Are you available to work outside of your neighborhood?
Yes
No
If Yes, how far?
5-10 miles
11-20 miles
21-30 miles
31-40 miles
4. Compensation and Work Hours
Clerks:
$115. Payment includes compensation for completing Election Day assignment and attending one (1) training class.
Machine Clerks: $130. Payment includes compensation for completing Election Day assignment and for attending two (2) training classes.
Supervisors:
$180 plus mileage. Payment includes compensation for completing Election Day assignment and attending two (2) training classes.
Bilingual:
$10 additional payment. Paid to workers specifically hired based on bilingual skills and who successfully complete bilingual testing.
Poll Workers are required to report to their assigned polling place at 6:00 a.m. and work the entire Election Day (approximately 9:00 p.m.).
5. Submission Instructions and Information
Return completed applications:
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By Email:
Scan or take picture of the application and email to pollworkers@sbcountyelections.com
By Fax:
(909) 387-2022
By Mail or in Person: San Bernardino County Elections Office, 777 E. Rialto Avenue, San Bernardino, CA 92415
For any questions, call the Elections Office at (909) 387-8300